Concussion Policy

Preamble 

1. This Policy is based on the 5th Consensus Statement on Concussion in Sport that was released in April 2017. This Policy interprets the information contained in the report that was prepared by the 2017 Concussion in Sport Group (CISG), a group of sport concussion medical practitioners and experts, and adapts concussion assessment and management tools.
2. The CISG suggested 11 ‘R’s of Sport-Related Concussion (“SRC”) management to provide a logical flow of concussion management. This Policy is similarly arranged. The 11 R’s in this Policy are: Recognize, Remove, Re-Evaluate, Rest, Rehabilitation, Refer, Recover, Return to Sport, Reconsider, Residual Effects, and Risk Reduction.
3. A concussion is a clinical diagnosis that can only be made by a physician. NUCLEUS SPORTS GROUP and its clubs accept no liability for participants or other individuals in their use or interpretation of this Policy.

Definitions

1. The following terms have these meanings in this Policy:
   1. “Participant” – Coaches, athletes, volunteers, officials, and other registered individuals
   2. “Registered Individuals” – All individuals employed by, or engaged in activities with the club, including but not limited to, employees, volunteers, administrators, committee members and directors and officers.
   3. “Suspected Concussion” – means the recognition that an individual appears to have either experienced an injury or impact that may result in a concussion or who is exhibiting unusual behaviour that may be the result of concussion.
   4. “Sport-Related Concussion (“SRC”) – A sport-related concussion is a traumatic brain injury induced by biomechanical forces. Several common features that may be used to define the nature of a SRC may include:
      1. Caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
      2. Typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
      3. May result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality may be visibly apparent.
      4. Results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.

Purpose

1. The club is committed to ensuring the safety of those participating in the sport of basketball. The club recognizes the increased awareness of concussions and their long-term effects and believes that prevention of concussions is paramount to protecting the health and safety of Participants.
2. This Policy provides guidance in identifying common signs and symptoms of a concussion, protocol to be followed in the event of a possible concussion and return to participation guidelines should a concussion be diagnosed. Awareness of the signs and symptoms of concussion and knowledge of how to properly manage a concussion is critical to recovery and helping to ensure the individual is not returning to physical activities too soon, risking further complication.

Recognize

1. If any of the following red flags are present, an ambulance should be called and/or an on-site licensed healthcare professional should be summoned:
   1. Neck pain or tenderness
   2. Double vision
   3. Weakness or tingling / burning in arms or legs
   4. Severe or increasing headache
   5. Seizure or convulsion
   6. Loss of consciousness
   7. Deteriorating conscious state
   8. Vomiting
   9. Increasingly restless, agitated, or combative
2. The following observable signs may indicate a possible concussion:
   1. Lying motionless on the playing surface
   2. Slow to get up after a direct or indirect hit to the head
   3. Disorientation or confusion / inability to respond appropriately to questions
   4. Blank or vacant look
   5. Balance or gait difficulties, motor incoordination, stumbling, slow laboured movements
   6. Facial injury after head trauma
3. A concussion may result in the following symptoms:
   1. Headache or “pressure in head”
   2. Balance problems or dizziness
   3. Nausea or vomiting
   4. Drowsiness, fatigue, or low energy
   5. Blurred vision
   6. Sensitivity to light or noise
   7. More emotional or irritable
   8. “Don’t feel right”
   9. Sadness, nervousness, or anxiousness
   10. Neck pain
   11. Difficulty remembering or concentrating
   12. Feeling slowed down or “in a fog”
4. Failure to correctly answer any of these memory questions may suggest a concussion:
   1. What venue are we at today?
   2. Which team is winning?
   3. Which quarter is it?
   4. What team are you playing against?

Remove

1. In the event of a Suspected Concussion where there are observable signs of a concussion, symptoms of a concussion, or a failure to correctly answer memory questions, the Participant should be immediately removed from participation.
2. Participants who have a Suspected Concussion and who are removed from participation should:
   1. Not be left alone (at least for the first 1-2 hours)
   2. Not drink alcohol
   3. Not use recreational/prescription drugs
   4. Not be sent home by themselves
   5. Not drive a motor vehicle until cleared to do so by a medical professional
3. A Participant who has been removed from participation due to a suspected concussion should not return to participation until the Participant has been assessed medically, preferably by a physician who is familiar with the Sport Concussion Assessment Tool – 5th Edition (SCAT5) (for Participants over the age of 12) or the Child SCAT5 (for Participants between 5 and 12 years old), even if the symptoms of the concussion resolve.
4. For Participants who have been removed from participation, the Participant’s parent/guardian should be immediately contacted. The Participant should be isolated in a dark room or area, stimulus should be reduced, the Participant should not be left alone, the Participant should be monitored, and any cognitive, emotional, or physical changes should be documented.

Re-Evaluate

1. A Participant with a Suspected Concussion should be evaluated by a licensed physician who should conduct a comprehensive neurological assessment of the Participant and determine the Participant’s clinical status and the potential need for neuroimaging scans.

Rest and Rehabilitation

1. Participants with a diagnosed SRC should rest during the acute phase (24-48 hours) but can gradually and progressively become more active so long as activity does not worsen the Participant’s symptoms. Participants should avoid vigorous exertion.
2. Participants must consider the diverse symptoms and problems that are associated with SRCs. Rehabilitation programs that involve controlled parameters below the threshold of peak performance should be considered.

Refer

1. Participants who display persistent post-concussion symptoms (i.e., symptoms beyond the expected timeline for recovery – 10-14 days for adults and 4 weeks for children) should be referred to physicians with experience handling SRCs.

Recovery and Return to Sport

1. SRCs have large adverse effects on cognitive functioning and balance during the first 24-72 hours after injury. For most Participants, these cognitive defects, balance and symptoms improve rapidly during the first two weeks after injury. An important predictor of slower recovery from an SRC is the severity of the Participant’s initial symptoms following the first few days after the injury. 
2. The table below represents a graduated return to sport for most Participants, in particular those that did not experience high severity of initial symptoms after the following the first few days after the injury.

Table 1 – Return to Sport Strategy

1. An initial period of 24-48 hours of both physical rest and cognitive rest is recommended before beginning the Return to Sport strategy.
2. There should be at least 24 hours (or longer) for each step. If symptoms reoccur or worsen, the Participant should go back to the previous step.
3. Resistance training should only be added in the later stages (Stage 3 or Stage 4).
4. If symptoms persist, the Participant should return to see a physician.
5. The Participant’s Return-to-Sport strategy should be guided and approved by a physician with regular consultations throughout the process.
6. The Participant must provide the club with a medical clearance form, signed by a physician, following Stage 5 and before proceeding to Stage 6.

Reconsider

1. The 2017 Concussion in Sport Group (CISG) considered whether certain populations (children, adolescents, and elite athletes) should have SRCs managed differently.
2. It was determined that all Participants, regardless of competition level, should be managed using the same SRC management principles.
3. Adolescents (13 to 18 years old) and children (5 to 12 years old) should be managed differently. SRC symptoms in children persist for up to four weeks. More research was recommended for how these groups should be managed differently, but the CISG recommended that children and adolescents should first follow a Return to School strategy before they take part in a Return to Sport strategy. A Return to School strategy is described below.

Table 2 – Return to School Strategy

Residual Effects

1. Participants should be alert for potential long-term problems such as cognitive impairment and depression. The potential for developing chronic traumatic encephalopathy (CTE) should also be a consideration, although the CISG stated that “a cause-and-effect relationship has not yet been demonstrated between CTE and SRCs or exposure to contact sports. As such, the notion that repeated concussion or sub concussive impacts cause CTE remains unknown.”

Risk Reduction and Prevention

1. The club recognizes that knowing a Participant’s SRC history can aid in the development of concussion management and the Return to Sport strategy. The clinical history should also include information about all previous head, face, or cervical spine injuries. The club encourages Participants to make coaches and other stakeholders aware of their individual histories.

Non-Compliance

1. Failure to abide by any of the guidelines and/or protocols contained within this policy may result in disciplinary action in accordance with the club’s internal policies.